Abstract
BackgroundRecent research suggests that Japanese inter-prefecture inequality in the risk of death before reaching 5 years old has increased since the 2000s. Despite this, there have been no studies examining recent trends in inequality in the infant mortality rate (IMR) with associated socioeconomic characteristics. This study specifically focused on household occupation, environment, and support systems for perinatal parents.MethodsUsing national vital statistics by household occupation aggregated in 47 prefectures from 1999 through 2017, we conducted multilevel negative binomial regression analysis to evaluate occupation/IMR associations and joinpoint analysis to observe temporal trends. We also created thematic maps to depict the geographical distribution of the IMR.ResultsCompared to the most privileged occupations (ie, type II regular workers; including employees in companies with over 100 employees), IMR ratios were 1.26 for type I regular workers (including employees in companies with less than 100 employees), 1.41 for the self-employed, 1.96 for those engaged in farming, and 6.48 for unemployed workers. The IMR ratio among farming households was 1.75 in the prefectures with the highest population density (vs the lowest) and 1.41 in prefectures with the highest number of farming households per 100 households (vs the lowest). Joinpoint regression showed a yearly monotonic increase in the differences and ratios of IMRs among farming households compared to type II regular worker households. For unemployed workers, differences in IMRs increased sharply from 2009 while ratios increased from 2012.ConclusionsInter-occupational IMR inequality increased from 1999 through 2017 in Japan. Further studies using individual-level data are warranted to better understand the mechanisms that contributed to this increase.
Highlights
The infant mortality rate (IMR), the number of deaths of children under 1 year of age per 1,000 live births in the same year, is an important measure of population health and serves as an indicator of the effect of economic and social conditions on the health of mothers and newborns.[1,2] Japan, like many other wealthy, developed countries, has a low IMR.[3]
This increase in inequality in regional child mortality may be linked to changes in some of the social determinants of child mortality observed across highincome countries that include relative poverty, income inequality and social policies, such as workplace maternal leave policies.[6,7,8]
As the IMR in farming households was higher than for other occupations when we calculated the descriptive statistics, we evaluated the relative predominance of farming in each prefecture, measuring farm density and used it as a proxy measure of the industrial structure in each prefecture
Summary
The infant mortality rate (IMR), the number of deaths of children under 1 year of age per 1,000 live births in the same year, is an important measure of population health and serves as an indicator of the effect of economic and social conditions on the health of mothers and newborns.[1,2] Japan, like many other wealthy, developed countries, has a low IMR.[3]. Nagata et al (2017) recently reported that inter-prefecture inequality in child mortality had increased since the 2000s.5. This increase in inequality in regional child mortality may be linked to changes in some of the social determinants of child mortality observed across highincome countries that include relative poverty, income inequality and social policies, such as workplace maternal leave policies.[6,7,8] As the relative poverty rate for children in Japan increased by 1.5 times from 1985 to 2012, it is possible that an expansion in social and economic differences might be affecting the IMR and increasing regional inequalities.[6,9]. This study focused on household occupation, environment, and support systems for perinatal parents
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